Certified Application Counselor Practice Test

Under which conditions must health insurers provide a Summary of Benefits and Coverage (SBC)?

1. When renewing existing plans, upon change of address, and upon request

2. Upon enrollment for the first time, at the start of each plan year, and upon request

3. At the beginning of each month and at the end of each year

4. Only at the consumer's request

The correct answer is: Upon enrollment for the first time, at the start of each plan year, and upon request

Health insurers are required to provide a Summary of Benefits and Coverage (SBC) to ensure that consumers have clear and comprehensible information regarding their health coverage. This requirement is rooted in the Affordable Care Act, which aims to promote transparency in health insurance. The correct conditions include providing the SBC upon enrollment for the first time so that new enrollees understand what their plan covers. Additionally, it must be provided at the start of each plan year to ensure that all members, whether new or renewing, are updated about the benefits covered and the cost-sharing responsibilities. Furthermore, insurers must provide the SBC upon request, allowing consumers to obtain this critical information whenever needed to make informed decisions regarding their healthcare coverage. In contrast, the other conditions outlined in the incorrect options lack some or all of these key timeframes and fail to comply with the statutory requirements designed to inform consumers about their coverage effectively.